Profile : Dr. Condom Gets Scant Protection From Critics : Flamboyant health secretary is labeled ‘moral pollutant’ for promoting AIDS prevention and birth control in Philippines.

When newly elected Philippine President Fidel V. Ramos unexpectedly named Juan M. Flavier as his secretary of health last summer, most Manila newspapers had no clipping files or photos of the little-known doctor.

They were in for a surprise.

Today, the 57-year-old rural health expert is arguably the country’s most controversial figure. The reason: his unexpected crusade to promote birth control and the use of condoms to slow the spread of AIDS in this Roman Catholic nation that is also one of Asia’s poorest and fastest-growing.

As a result, Flavier has been vilified in the nation’s churches, bashed in editorials as a “condom pusher” and “moral pollutant,” and denounced in the Philippine Senate for supporting “promiscuity, lechery, adultery and sexual immorality.”

“I can’t even spell those words,” Flavier jokes in response. And the diminutive doctor denies he’s at war with the Roman Catholic Church, which opposes any artificial birth control. “When you’re only 4-foot-11, you don’t make war,” he says with a grin. “You make love.”

The flak flew heaviest when the impish Flavier handed out condoms to Cabinet ministers and local reporters two days before Ramos left on a state visit to Thailand, where AIDS is rampant. Nor are critics amused when he starts speeches “on the sperm of the moment” and hopes for “a standing ovulation.”

But the flamboyant Flavier says he welcomes the attacks. Huge headlines, TV talk shows and calls for his resignation only help publicize his campaign for contraceptives, he insists.

Open advocacy of birth control has been taboo for nearly a decade in the Philippines. Successful family planning programs begun by Ferdinand Marcos stalled in the early 1980s as his regime began to crumble. His successor, Corazon Aquino, a devout Catholic who took office in 1986 with the help of Manila’s powerful prelate, Cardinal Sin, then gutted even the facade of a population program.

By 1990, a study of more than 5,000 barrio and rural health clinics found that fewer than 2% had trained family planning workers or sufficient supplies of contraceptives, according to the U.N. Population Fund. And none of 192 government hospitals had trained staff or supplies.

There was an increase in unsafe abortions. Although abortions are illegal, health officials estimate 750,000 pregnant women have them each year. The often unsanitary operations, primitive procedures and poisonous purgatives now constitute one of the leading causes of death among women admitted to hospitals.

The population rocketed ahead by an annual 2.48%, the highest rate in the region. It now stands above 64 million people, according to census figures. That could double in 30 years. Just keeping pace now means creating 800,000 jobs a year in a country where half the people already live in urban slums or appalling rural poverty.

Ramos, the country’s first Protestant president, fears a booming birthrate will overwhelm his attempts to jump-start the economy. “If we are to catch up with our neighbors in Southeast Asia,” Ramos said recently, “we must harness our forces and cut . . . population growth.”

That’s anathema to the church here. So is Ramos’ endorsement of the use of condoms to fight AIDS. The Philippines has 368 confirmed cases of people with the virus that causes AIDS, including 89 cases of full-blown AIDS. Most are women.

But Flavier and other officials say the total is probably at least 10 times higher. A full-scale epidemic is “still preventable,” Flavier said. “If we do nothing, five years from now, we might be another Thailand.”

Thailand’s own colorful anti-AIDS campaigner, Meechai Viravaidya, clearly agrees. He sent a small floral bouquet of multicolored condoms that Flavier displays on his desk.

Catholic leaders are not so enthusiastic. In a pastoral letter read in thousands of churches on Feb. 7, the Catholic Bishops Conference of the Philippines condemned condoms as a “simplistic and evasive” approach to AIDS that creates a “false sense of complacency.” The best protection, it said, is “chastity and the refusal to engage in extramarital sexual activity.”

“Furthermore, we have a well-founded anxiety,” the letter goes on, that the promotion of condoms to prevent AIDS “is part of the drive to promote the acceptability of condom use for contraception.”

The most public critic, Sen. Francisco Tatad, a member of Opus Dei, the zealous Vatican-sanctioned lay society, has demanded Flavier’s resignation. Tatad calls his conduct “disgraceful,” his family planning program unconstitutional and his promotion of condoms unacceptable. Overpopulation will never be a problem in the Philippines, Tatad insists. “The correcting mechanism of nature will take care of overcrowding,” he said in an interview.

Tatad admits he holds extreme views. The father of seven opposes the rhythm method and other forms of natural contraception, which the church permits, for example. And he sparked outrage when he told the Senate that “if I were a woman, married and of childbearing age, I would be pregnant most of the time.”

Tatad argues that the government should have no role in family planning, even to help the poor. “The government does not provide for all their needs,” he said. “Many cannot afford to eat. The government does not provide them food. Why be particular about contraception?”

Flavier, who is Catholic, says he supports the church’s call for celibacy and monogamous relationships. But he said the hard-liners are out of touch.

“I have a surprise for them,” Flavier said of the bishops. “I have more and more priests and nuns teaching family planning.”

Actually, the real surprise is Ramos’ support. He repeatedly refused to challenge Aquino’s population policy after she endorsed him in last year’s presidential race. But after taking office, Ramos announced “population management” as a priority and gave the job to Flavier.

Flavier studied medicine at the University of the Philippines, then earned a master’s degree in public health from Johns Hopkins University in Baltimore. He spent 31 years working in rural areas and heads the Philippine-based International Institute for Rural Reconstruction, which aims to alleviate rural poverty.

Flavier also helped found the Family Planning Organization of the Philippines, the nation’s largest and oldest family planning group. Although he had never worked in government, he decided the job as health secretary was too important to pass up. “They told me: ‘You’re doing good things. But you’re doing it too small. Do it nationwide.’ ”

So he’s trying. His goal is 2.1% annual population growth by the year 2,000, a level that in theory would produce zero population growth a decade or so later. It won’t be easy.

“I’m still not allowed to put family planning as a line in the budget,” Flavier said. “It’s very embarrassing.”

So, as before, foreign donors are paying the bills. The U.N. Population Fund allocated $25 million over five years for training, medical equipment and supplies. Washington has promised $40 million, and has helped train 4,000 family planning workers. More aid may come from the World Bank and several European governments.

One goal is to conduct the Philippines’ first AIDS surveillance program. The focus will be on urban red-light areas, military camps, universities, returning overseas workers and truck drivers. Blood banks will be registered. Non-governmental groups will be enlisted and local governments encouraged.

“We’re at a crucial point,” said the Western aid official. “We have a political commitment from the top. We’ve got demand from the people. So now we’re focusing on providing the infrastructure to provide the services. The important thing is people want the services.”

That was obvious on a recent muggy morning beside a barrio of tin-roofed shacks and shops near the Church of San Miguel, home to one of Manila’s most conservative bishops. About 50 people, including many children, gathered as a sound truck announced a street theater.

Soon the star arrived. It was “Super Trust,” an actor dressed as a 6-foot condom, complete with a blue satin cape and wraparound sunglasses. The play was “Kondom Kapers,” sponsored by the Trust Quality brand of condoms and performed twice daily around Manila.

Children squealed, parents applauded and dogs barked as the giant grinning condom vanquished a black-robed AIDS figure with a grinning skull. The crowd laughed as a well-dressed young couple, too embarrassed to say condom , asked a shopkeeper for a Coke, a candy and a condominium instead.

And most important, adults flocked around afterward to get free condom samples and comic books and pamphlets on family planning and AIDS. “We need proper ways to use birth control,” said Christie Manalli, a mother of two who sells lottery tickets in the barrio.

Flavier isn’t surprised. “Times are changing,” he said. “No matter what they say, AIDS is a reality. . . . My message is be good. If you can’t be good, be careful. If you can’t be careful, use a condom.”

Biography

* Name: Juan Martin Flavier

* Title: Secretary of health.

* Age: 57

* Personal: Born in Manila slum. Doctor of medicine, 1960, University of the Philippines. Master’s in public health, 1969, Johns Hopkins University. Published six books on village life, including “Doctor to the Barrios,” translated into eight languages. Married to Alma Susana Aguila; four children.

* Quote: “Public awareness is the name of the game in public health.”